Implementation of Standardized Discharge Rounds as a Tool to Decrease Length of Stay in an Acute Care Hospital

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Publication Date

4-20-2017

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Advisor:

MR Cooper, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA

Abstract

Heart Failure is a growing national problem. This diagnosis uses more resources through the continuum than any other diagnosis. The incidence and prevalence of heart failure patients in the health system created an impetus for improving care while reducing total costs. Upon admission and during hospitalization, opportunities exist for hospitals to enhance care that patients receive during hospitalization, facilitate discharge planning and improve post-discharge care while reducing the total cost of care. Discharge planning is an integral but ill-defined process in most acute care settings. The purpose of this project was to assess the effectiveness of standardized discharge rounds as a tool in the enhanced heart failure care model to decrease length of stay of inpatient hospitalization. The DMAIC model for process improvement was used by a multidisciplinary team formed to create a standardized rounding process. Analysis of current discharge rounds revealed that there were many gaps from recommended practice. A standardized process was established and piloted on a telemetry unit of an acute care hospital for a three-month period. Process measures for attendance, duration and occurrence of rounds were collected. Length of stay for the telemetry unit was measured before and after the implementation of the new rounding model. Reasons for delays were also observed during the pilot period. The process measure provided real time feedback to the project team and allowed for redesign and testing of the format over the three-month period until the desired results were achieved. Lengths of stay results were mixed. The institution of the standardized rounds could be associated with a recent decrease on the length of stay for the unit. Discharge rounds are viewed as a value-added activity to coordinate care and prevent delays in discharge. The project will continue in the control phase until leadership feel that the hospital is getting the desired results and the process is hardwired.

Presentation: 29:32

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